卵巢子宫内膜异位囊肿剥除术中EFI评分对术后IVF-ET妊娠结局的预测价值研究

目的:研究腹腔镜手术中子宫内膜异位症生育指数(EFI)评分对卵巢子宫内膜异位囊肿不孕症患者术后体外受精-胚胎移植(IVF-ET)妊娠结局的预测价值。方法:选择2016年1月1日-2018年12月31日中国人民解放军空军军医大学第二附属医院生殖医学中心行腹腔镜下卵巢子宫内膜异位囊肿剥除术,并于术后行IVF-ET助孕的不孕症患者共93例,记录其术中、术后及IVF-ET过程中的临床资料,根据妊娠结局分为未孕组和妊娠组,对比2组患者的基本资料、术后抗苗勒管激素(AMH)水平、术中EFI评分,行多因素分析并绘制受试者工作特征曲线(ROC曲线)评估术中EFI评分对妊娠结局的预测价值。结果:2组患者的术后AMH水平和术中EFI评分比较,差异有统计学意义(P<0.05)。在患者基本资料相似的情况下,术中EFI评分是影响妊娠结局的独立因素,EFI评分越高,妊娠率越高。单用EFI评分的ROC曲线下面积(AUC)为0.709(95%CI:0.604~0.814),其预测妊娠结局的敏感度为0.867,特异度为0.521,其最佳阈值为5.5分。EFI评分和术后AMH联合预测妊娠结局的AUC为0.793(95%CI:0.626~0.833),其预测的敏感度为0.867,特异度为0.521。EFI评分单独预测和联合术后AMH值预测的特异度和敏感度比较,差异无统计学意义(P=0.125)。结论:术中EFI评分可用于预测术后IVF-ET妊娠结局,当EFI评分>5.5分时,患者妊娠率明显增加,临床对于EFI评分较低的患者,IVF-ET助孕前要给予充分的评估并慎重选择促排卵方案及移植策略,从而改善妊娠结局。

Predictive Value of Fertility Index in Pregnancy Outcome of In Vitro Fertilization-Embryo Transfer after Chocolate Cyst Removal

Objective: To assess the predictive value of fertility index in the pregnancy outcome of in vitro fertilization-embryo transfer(IVF-ET) after chocolate cyst removal in patients with endometriosis. Methods: From Jan. 1,2016 to Dec. 31, 2018, 93 infertility patients underwent the laparoscopic ovarian chocolate cyst removal and IVF-ET treatment after operation in our hospital. The clinical data were recorded. On the basis of pregnancy outcomes, the patients were divided into the non-pregnant group and the pregnant group. The basic data, AMH value and EFI score were compared between the two groups. The predictive value of EFI score for pregnancy outcome was evaluate by multivariate analysis and ROC curve. Results: There were significant differences in the AMH level and EFI score between the two groups(P <0.05). EFI score is an independent factor affecting pregnancy outcome in those patients with similar basic data. The higher EFI score, the higher pregnancy rate. The area under curve(AUC) of the ROC curve of EFI was 0.709(95%CI: 0.604-0.814). The critical value of this AUC was 5.5, with the sensitivity of 0.867 and the specificity of 0.521. The AUC of the ROC curve of EFI combined with postoperative AMH was 0.793(95% CI: 0.626-0.833), and its critical value was 5.5, with the sensitivity of0.867 and the specificity of 0.521. There were no differences in the specificity and the sensitivity between EFI score predicting alone and EFI score combined with postoperation AMH(P=0.125). Conclusions: EFI score can be used to predict the pregnancy outcome of IVF-ET after operation. When EFI score is greater than 5.5, the pregnancy rate of IVF-ET will increase significantly. Patients with low EFI score should be fully evaluated before IVF-ET treatment, and the strategy of ovarian stimulation for those patients should be carefully selected.